Corneal Neurotization: A Novel Solution to Neurotrophic Keratopathy

Background: This study was designed to evaluate the efficacy of direct corneal neurotization using contralateral supraorbital and supratrochlear nerves in patients with unilateral facial palsy and corneal anesthesia. A novel surgical procedure in which these donor nerve branches are inserted at the contralateral anesthetic corneal limbus for sensory neurotization is described. Methods: The charts of six patients were reviewed thoroughly to evaluate changes in corneal sensibility following surgery for direct corneal neurotization. Visual acuity, blink reflex, donor deficit, synesthesia, long-term corneal health, and several psychosocial measures and overall patient satisfaction with the procedure are reported. Results: Six patients with an average denervation time of 7.00 +/- 8.56 years before surgery were followed for an average period of 16.3 +/- 2.42 years. All six eyes showed improvement of corneal sensibility, visual acuity, and corneal health and remained free of ulcers or other signs of advancing neurotropic keratopathy. Average corneal sensibility improved from 2.00 +/- 4.47 mm before surgery to 278.00 +/- 226.00 mm following corneal neurotization (p < 0.016). Conclusions: Direct neurotization of the cornea using the contralateral supraorbital and supratrochlear branches of the ophthalmic division of the trigeminal nerve appears to be an effective method of restoring the corneal sensibility in patients with unilateral facial palsy and anesthetic cornea. This technique preserves ocular anatomy and cosmesis and restores function by improving corneal health and visual acuity. (Plast. Reconstr. Surg. 123: 112, 2009.)